Juwel Rana and Shahriar KhandakerGlobally, tobacco epidemic is considered to be the most prominent preventable cause of death, responsible for taking lives of an estimated figure of 6 million people a year; 600,000 of the victims are second-hand smokers or non-smokers (WHO, 2015). The World Heart Federation presages that the number of deaths caused by smoking is expected to rise up to more than 8 million a year by 2030. Most of the smokers (80 per cent) hail from low and middle income countries where the burden of tobacco-related diseases and death is paramount. Tobacco smoking is a key risk factor for lung cancer, respiratory disease and heart disease that cause most deaths globally, as well as nationally.
In Bangladesh, every year 2.5 lakh people die from tobacco-related diseases meaning 28 deaths per hour (WHO, 2015). On the other hand, the Health Minister of Bangladesh has claimed in a recent press conference that one lakh people die per year nationally from tobacco-related diseases and illness thus the death rate per hour stands at 11. Why middle and lower income countries like Bangladesh are more vulnerable to smoking? Diseases related to smoking are curable but people do not have sufficient access to healthcare. If they have access, the quality of healthcare is below par. They cannot afford the healthcare services as tobacco smoking escalates healthcare expenditure and economic vulnerability. As a result, death becomes the ultimate outcome which denotes the structural failure to ensure maximum health coverage for vulnerable and poor people. Tobacco users are also more susceptible to drug addiction as 95 per cent of total drug addicts smoke tobacco (WHO, 2015).
All member states of the United Nations including Bangladesh are observing World No Tobacco Day today (31 May). In 1987, the associated countries of World Health Organization (WHO) proclaimed 31st May as World No Tobacco Day with an emphasis to discourage any kind of tobacco consumption through disseminating its negative impacts. The theme of World No Tobacco Day 2016 is to get ready for plain packaging: a measure to restrict or prohibit the use of logos, colours, brand images or promotional information on packaging other than brand names and product names displayed in a standard colour and font style. WHO expects that it will increase the effectiveness of pictorial health warning. In accordance with WHO, Bangladesh has already taken various measures such as mass media campaigns, bans on tobacco promotions, increasing taxes on tobacco products, hard-hitting anti-tobacco advertisements, and graphic pack warnings. Despite that, 2.5 crore people consume tobacco every day in Bangladesh. The number of active tobacco smokers comprised of 45 per cent adult male and 2 per cent female. Majority people know that tobacco consumption is injurious to health. The figures make us confront the question as to what stimulates an individual to smoke in the first place and why don't they quit. Then why does antismoking campaign fail to influence people in quitting smoking as well as why the state does not ban tobacco completely?
Peer pressure, media influence and experimentation are major factors which influence people particularly the adults to become smokers. Peer groups or friends play the main role in starting smoking. Young people perceive that smoking makes them cool and smart. Adults learn smoking from their favourite film stars who smoke in movies. Working class people also perceive smoking is a way of relaxing them from stress and tensions. Thus, people learn to smoke from their friends, mass media, social context, and the environment through observing and imitating others. Simultaneously, movie or mass media advises people to restrain from smoking which questions anti-tobacco campaign. Most of the young people start smoking with experimentation. They want to experiment with smoking to obtain the 'cool' and 'macho' experience, and to get a feel of smoking. As a result, adults become active smokers due to the addictive substance called nicotine present in cigarettes. Albert Bandura dubbed this 'Social Learning' process.
Do people have knowledge and awareness about the harmful impacts of tobacco intake? The vast majority of the people are aware of the negative consequence of smoking, even at the point of purchase from the cigarette pack. According to the Global Youth Tobacco Survey 2013, seven in ten students noticed anti-tobacco message in media such as smoking causes cancer and heart disease. On June 2015, the government of Bangladesh ran a powerful mass media campaign highlighting the specific dangers of second-hand smoke to children such as 'Tobacco is eating your baby alive', and to discourage smoking to save lives. It is estimated that about 7.3 crores Bangladeshis aged between 15 and 64 years may have been exposed to the campaign (World Lung Foundation, 2015). Besides, almost every year, the government increases tax on tobacco and raises the price of tobacco products which include cigarettes. The government has also banned the promotional advertisements on tobacco products.
But why after all these interventions and policies do people not quit smoking? Why the enduring prevalence rate? There are twofold reasons for this. One, anti-tobacco campaign has failed to motivate individuals to quit smoking. Anti-tobacco campaigns generally highlight serious health problems caused by smoking, which comprise of the more informative campaigns. Due to shocking information and the high price of tobacco products, people think about quitting smoking but it does not motivate enough smoking cessation. Because people do not perceive that smoking poses many threats. Use of fear tactics to portray negative health effects of smoking in anti-tobacco messages are very common. Fear tactics do not trigger off any effect as people feel that they are far-fetched, bearing no resemblance to reality. Thus, the logical approach of informing the audience about smoking health risks in the advertisement is ineffective because active smokers are not impressed with a health scare. People also do not believe that particular behavioural change will reduce the susceptibility of those diseases. An individual does not feel that he/she is capable of quitting smoking. This is the lack of self-efficacy among individuals. The health belief model and social learning approach both have substantial arguments in favour of this. Hence, the emotional appeal would assist in helping people to quit. Anti-tobacco campaigns should target people in an emotional way, more emotional towards the people who care about them such as their mother, future wife, kids, and friends.
Secondly, the large-scale structural failure is also responsible for this epidemic. The government launches anti-tobacco campaigns despite their ineffectiveness. At the same time, there are different laws and regulations to control tobacco use bu they are not enforced. These question the intention of the government and anti-tobacco campaigns. Anti-tobacco campaign itself is a business nexus that generates money. Therefore, these campaigns are amere show off responsibilities towards the people rather than controlling tobacco. Individuals are not capable enough to quit smoking easily, then why the anti-tobacco campaigns are targeting individuals? If the government is absolutely keen to control tobacco use, why does not it target those people who are producing and marketing tobacco products or why does not it ban tobacco completely?r
Juwel Rana and Shahriar Khandaker are university teachers and researchers